Pilonidal Disease of Natal Cleft Clinical Trial
Official title:
Assessment of the Effect of Platelet Rich Plasma on the Healing of Operated Sacrococcygeal Pilonidal Sinus by Open Method
The aim of the study is to assess the healing promotion effect of platelet rich plasma in patient being operated for sacrococcygeal pilonidal sinus disease by open excision
Sacrococcygeal Pilonidal disease is an infection of the skin and subcutaneous tissue at or
near the upper part of the natal cleft of the buttocks. Pilonidal cavities are not true cysts
and lack a fully epithelialized lining; however, the sinus tracts may be epithelialized.
Pilonidal sinus disease (PNS) has an incidence of approximately 26 per 100,000 population
with a male predominance of 2:1 and the mean age of those affected is from 19 to 30 years of
age. It occurs rarely after the age of 45 and children.
Pilonidal sinus disease is characterized by natal cleft suppuration due to hair follicle
infection. The disease results from chronic infection of hair follicles and subsequent
formation of a subcutaneous abscess because of persistent folliculitis. Hair then enters the
abscess cavity and provokes a foreign body tissue reaction; chronic suppuration and discharge
through a midline sinus follow.
Some individuals are asymptomatic with midline pits in the sacrococcygeal area, Symptomatic
Pilonidal sinus results in chronic discharging wounds that cause pain and impact upon quality
of life and social function. These sinuses may become infected and present as acute
abscesses. Management of these abscesses is uncontroversial and revolves around incision and
drainage, however, the mode of surgical management of the chronic discharging sinus is
variable, contentious, and problematic.
The Principles of Surgical strategies require eradication of the sinus tract, complete
healing of the overlying skin, and prevention of recurrence. Many methods are available for
surgical management of PNS which is treated by wide excision. After excision, the wound may
be left open to heal with granulation tissue, or may be immediate closed with a midline
closure or by using a flap (Z-plasty, karydakis, Bascom or Rhomboid flaps). However, there is
not yet a consensus on the optimal treatment.
Excision and healing by granulation is still preferred due to the low recurrence rate of
(3.4%) compering with other methods (20.6%) for midline closure and (10.3%) for off-midline
closure but the healing time is lengthy and requires a prolonged time of daily dressing with
a risk of infection and delayed wound healing. Therefore, the search for a treatment with
minimal pain, accelerated healing time and a short span of time for returning to the normal
daily activities is vastly pursued.
A recent method to promote the wound-healing process is the local administration of an
autologous platelet concentrate suspended in plasma named as platelet rich plasma (PRP) which
contains growth factors. Concentrated growth factors have been reported to accelerate wound
healing by 30-40% giving a satisfactory outcome in the treatment of chronic skin and soft
tissue lesions, maxillofacial and plastic surgeries by presenting these high amounts of
growth factors and chemokines.
When platelets become activated, Seven fundamental protein growth factors that are actively
secreted by platelet initiate all wound healing process, including platelet derived growth
factor (PDGF), epidermal growth factor (EGF), transforming growth factor (TGF), vascular
endothelial growth factor (VEGF), Fibroblast growth factor (FGF), connective tissue growth
factor (CTGF) & insulin like growth factor (ILGF 1) all participate in the acceleration of
wound-healing process.
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